High Yield 6 Flashcards

Question

Management of hematuria associated w/ exertion + RTP

Answer 1

Step 1: If pt <40 y/o, observe + repeat UA in 48hrs If normal, no further ix warranted If hematuria persists, move to step 2 Step 2: urine culture, Cr, eGFR, PT, PTT, CK If normal, move to step 3 Step 3: cystoscopy If normal, proceed to step 4 Step 4: US or CT KUB If normal, consider renal arteriogram or renal biopsy RTP 48hrs if hematuria has resolved

Answer 2

age >40 years, tobacco use, analgesic abuse, pelvic irradiation, occupational exposure to dyes or rubber compounds, constitutional symptoms (weight loss, fatigue, anorexia)

Answer 3

Transient increase in urine protein, resolves over 24-48hrs D/t increased glomerular permeability

Answer 4

Glomerular: Increased filtration of macromolecules across the glomerular capillary wall Seen with mild-to-moderate exercise Tubular: Decreased resorption of filtered proteins Seen in strenuous exercise in combination with glomerular proteinuria Overflow: Increased production of low-molecular-weight proteins (e.g., multiple myeloma) Unless preexisting condition is present, not seen in exercise-induced proteinuria

Answer 5

Exercise type, intensity, duration Hx of renal dz Hx of recent illness

Answer 6

Signs of underlying renal dz: Elevated blood pressure (BP) Peripheral edema Flank pain Abdominal bruits

Answer 7

UA CBC, Cr, eGFR If persistent, renal US

Answer 8

Orthostatic proteinuria (elevated protein when upright) Fever Stress Pregnancy Szs Glomerular causes (e.g., minimal change disease, membranous glomerulonephritis) Tubular causes (e.g., hypertensive nephrosclerosis) Overflow (e.g., multiple myeloma, hemoglobinuria) Postrenal causes in patients with inflammation of the urinary tract (e.g., urinary tract infection (UTI), nephrolithiasis, tumors)

Answer 9

Symptoms: Fatigue, weakness, decrease in performance, light headedness, palpitations, SOB, pica (iron), paresthesias (B12) Diet (vegetarian, restrictions, gluten free, meat, leafy greens) Menstrual history in females Blood in stool, melena, bowel habits, bloating & gas Hematuria Family history (Celiac, bleeding disorders)

Answer 10

Pallor-check conjunctiva Flow Murmur Tachycardia Abdominal/rectal exam if appropriate

Answer 11

Fatigue work-up: CBC, ESR, ferritin, serum iron, TIBC, B12, folate, TSH, peripheral smear (optional: B-HCG, monospot, drug screen, Hep screen) If suspect GI cause then stool for occult blood, endoscopy/colonoscopy Celiac screen if GI symptoms or FHx: TTG Urinalysis, C&S if hematuria Retic count Stools for occult blood

Answer 12

Microcytic: Iron deficiency Thalassemia ACD Normocytic Iron deficiency ACD B12 or folate def Drug induced Infection Liver dz or alcohol use Hemolysis Hypothyroidism Macrocytic B12 or folate def Drug induced MDS Liver dz or alcohol use Hypothyroidism High retic count

Answer 13

Treat cause! (dietician if poor diet, OCP if heavy periods, gluten free diet etc.) Iron supplementation for iron deficiency anemia Ferrous fumarate 300 mg OD-BID, ferrous sulphate or gluconate 300mg BID-TID, Hb should increase by 1g/dL per week. If not then check retic count Continue therapy for at least 3 months then monitor. IM iron can increase Hb faster but no proof that improves performance.

Answer 14

Syncope - rest or exertion? Associated symptoms: chest pain, dyspnea, lightheaded, n/v, diaphoresis, syncope Symptoms of hyperthyroidism (increased energy, diarrhea, increase appetite, ophthalmopathy) Caffeine intake Smoking Drug and alcohol use inc cocaine Eating disorder Stress Fever Meds: cold or flu meds inc ephedra

Answer 15

Vitals Listen to heart sounds - dynamic (supine + standing) Peripheral pulses Listen to chest Check thyroid

Answer 16

12 lead ECG + Holter Echo Exercise stress test CBC, lytes, TSH

Answer 17

Anxiety disorder, panic attacks Angina Costochondritis Neurocardiogenic syncope Heat stroke Seizure Thyroid dysfunction

Answer 18

Reassure Avoid caffeine, alcohol, tobacco, stress Educate re: valsalva, carotid massage Consider ablation if symptomatic BB are banned in some competitive sports If symptoms controlled, no restrictions to sport participation

Answer 19

Left shoulder pain Relieved w/ rest Associated sx: SOB, pre syncope, N/V, palpitations, sweating

Answer 20

ECG Stress test Cholesterol, glucose

Answer 21

Smoking, cholesterol, HTN, fam hx

Answer 22

Rx GTN Referrals Cardiology FU Go to ED if sx not resolving FU w/ GP

Answer 23

Hypothyroidism Hypercortisolism Hypothalamic dysfunction Growth hormone deficiency Prader-Labhart-Willi syndrome Bardet-Biedl syndrome Pseudohypoparathyroidism Polycystic ovary syndrome (PCOS) Hypogonadism Insulinoma Menopause

Answer 24

Socio economic factors, genetic factors, insulin resistance, poor diet, insufficient activity, insufficient sleep, associated medical illnesses, medications, smoking session, excess alcohol intake

Answer 25

Wt history Diet Eating patterns Exercise Mental health

Answer 26

BMI Waist to hip ratio Thyroid exam

Answer 27

CBC, fasting glucose, LFTs, lipids, TSH, T4, morning cortisol, UA, a1c DEXA body fat composition

Answer 28

Diet: calorie restricted/low-fat or low carb. Reduce sugar sweetened drinks, reduce starchy foods, reduced processed grains, reduce foods with hidden sugars. Behavioural therapy. Medications: appetite suppressants (phentermine, liraglutide) or orlistat (pancreatic + gastric lipase inhibitor) Bariatric surgery (gastric banding, gastric bypass, gastrectomy) Exercise prescription Moderate intensity 5-6 days per week, 45-60mins Focus on large muscle group aerobic activities

Answer 29

Inform and educate people, counselling and healthcare, healthy urban design, improving food and drink supply, marketing restrictions, labelling and packaging, incentives for healthy living, school meals

Answer 30

Physical activity recommendations - frequency, intensity, time, type Progression Exercise is good for mental health Improving fitness is more important than losing weight

Answer 31

Brisk dog walks Take stairs Park far away Yard work Cleaning w/ weights

Answer 32

Train at least three hours after a meal Limit fat and protein content in the meal before exercise. Prevent dehydration eat small amounts before and during exercise. Avoid high fibre foods prior to competition. If pre-comp anxiety is likely cause, see sports psychologist

Answer 33

Aim to expend at least 1000 calories/ week Progressive resistance training with lower resistance + intensity, use major muscle groups Check sugars pre + post exercise and during if prolonged Reduce insulin that will be acting at time of exercise Exercise approximately 60 mins after meal Increase carb intake pre + post exercise Avoid injecting sites involved in activity Wear medic alert bracelet Educate on signs of hypoglycemia Always have supply of fast acting glucose Exercise with a buddy

Answer 34

Peripheral neuropathy Avoid trauma to feet, non wt bearing activity preferred Autonomic neuropathy Recommend exercise testing to document BP, HR, temp, blood sugar response Emphasise Borg scale of rating perceived exertion Proliferative retinopathy Avoid activity that may increase BP >180 + avoid scuba diving

Answer 35

Recommend moderate aerobic activity 2.5 hrs per week Muscle strengthening >2 days per week once aerobic fitness has improved Daily flexibility Start slow, slow cool down, avoid breath holding, avoid head lower than heart exercises Stop if feeling dizzy, sick, unwell FU w/ doc if getting CP, palpitations, SOB, blackouts

Answer 36

Focus on functionality exercises Repeated short bouts of low intensity activity daily Exercise affected joints with pain free ROM Avoid overstretching Avoid vigorous, repetitive exercise on affected joints Avoid morning exercise in RA

Answer 37

Exercise stress test first

Answer 38

Moderate impact within limits of pain 4-5/wk High intensity resistance training 2/wk Balance training 4/ wk Avoid deep forward spine flexion. Avoid explosive movements and high impact loading + dynamic abdo exercise

Answer 39

Daily exercise Walking strongly recommended PRT with emphasis on shoulder girdle and inspiratory and upper extremity muscles is important

Answer 40

Focus on daily activity that use large muscle groups and increase total energy expenditure Equipment modifications Hyperthermia risk increases, emphasize importance of hydration + proper clothing

Answer 41

Slower progression needed. Maybe immune compromised so should avoid public gyms and swimming pool Heart rate may be less reliable for monitoring intensity Patience with lymphoedema should wear compression sleeves during resistance training Several short of exercise may be better than one single bout Increased risk of fractures due to bony mats Patients undergoing radiation should avoid chlorine exposure

Answer 42

Aerobic exercise five days a week, resistance training two days a week, balance three days a week and flexibility twice a week

Answer 43

Check CI Stress test + echo

Answer 44

Kayaking, golfing, side bends, bow and arrow, rowing, latissimus pulldown, yoga, chest stretches

Answer 45

balance on different surfaces, reduce reliance on vision and external cues stability exercises, exercises with eyes closed, exercises with head turns

Answer 46

Walking, agility exercises, lunging

Answer 47

Boxing, kettlebell swings

Answer 48

Obstacle courses, quick tens in corners, lunging, boxing, kettle bell swings.

Answer 49

Stability ball exercises, kettlebell, lunging, tai chi, boxing

Answer 50

Uhthoff’s effect can cause worsening of neurological symptoms if body temperature rises, therefore environment is important, call shower before and after, wearing cooling vest, activities are good

Answer 51

Climbing, flying, hang gliding, shooting, diving, archery, skydiving and motor racing all contraindicated. Skiing, cycling and swimming or contraindicated unless under supervision.

Answer 52

Myocarditis, cardiomyopathy, coronary artery anomalies, vascular Ehlers Danlos

Answer 53

Questionnaire for ages 15-69 to assess readiness to exercise

Answer 54

Reduced risk of premature death, cardiovascular disease, stroke, high blood pressure, high cholesterol, type two diabetes, gestational diabetes, metabolic syndrome, depression and anxiety. Reduced risk of bladder, breast, colon, endometrial, esophageal, renal and gastric cancer Prevention of weight gain, decreased pain improved physical function in arthritis, prevention of fools, improve cognitive function, improve to sleep quality, lower risk of hip fracture and lung cancer, increased bone mineral density

Answer 55

MSK injuries including strains, tears, fractures, tended of these, dislocations and bursitis. Rhabdomyolysis, acute M.I, malignant arrhythmias, sudden cardiac death. Exercise induced bronchoconstriction. Heat stroke, dehydration.

Answer 56

Assess, advise, agree, assist, arrange.

Answer 57

Chest and shoulders: push-up, bench press, overhead press Back: pull up or chin up, latissimus pulldown, bent over row Core: plank, side plank, bicycle crunch Arms: arm, tricep pull down Lower body: squats, dead left, seated leg press, side leg raise, car raise

Answer 58

150 minutes of moderate intensity aerobic activity through the week. Aerobic activity should be in about at least 10 minutes. Muscle strengthening activities involving major muscle groups on two or more days a week. Adults over 65 with poor mobility should perform activity on three or more days a week to enhance balance and prevent falls

Answer 59

Rating of perceived exertion (RPE) Heart rate Oxygen consumption (VO2 max)

Answer 60

Reduce all forms of screen time. When using a screen, schedule five minute breaks every 45 minutes to go for a walk during TV ads, perform exercises. Only watch TV when on a stationary bike or treadmill Walk to work Park further away Take the stairs Standing desk

Answer 61

Physical ailments or chronic conditions Fear of becoming injured. Lack of time. Lack of knowledge Self-consciousness. Low social economic factors Lonely safety Poor weather Lack of walking and cycling networks Lack of open public greenspaces Financial costs Transport Lack of availability or access to physical activity programs Lack of motivation Low self efficacy

Answer 62

SOB Localised chest pain, worse w/ deep inspiration - may radiate to neck, back, shoulder or abdo May be asymptomatic

Answer 63

Decreased/ absent breath sounds on affected side Decreased tactile fremitus Unequal expansion of chest w/ inspiration Hyperresonance to percussin SC emphysema Tension pneumothorax: distended neck veins, displacement of cardiac apex beat to non affected side, deviation of trachea to non affected side

Answer 64

Tall, thin, young, males Smoking Substance use (heroin, ecztasy, marijuana, cocaine) Underlying lung dz (COPD, CF, TB) Connective tissue disorder (Marfans) Trauma (commonly first 4 and last 2 rib #, multiple rib #, flail segments, scapular #)

Answer 65

CXR - upright PA + lateral chest films White visceral pleural line seen Rib XRs ECG - right axis deviation, decreased QRS amplitude, precordial T wave inversion

Answer 66

Lung contusion Costochondral separation Muscle strain #

Answer 67

Support ABCs O2 Semi-Fowler position Needle decompression w/ 18G into 2nd IC space at midclavicular line If small, no chest tube needed - just monitor for min 6 hrs, FU CXR in 12-48 hrs If large, pleural aspiration If this fails, or if pt unstable, insert chest tube (16-22Fr) Use lidocaine If hemothorax, insert chest tube VATS indications: If pleural aspiration fails Recurrent primary spontaneous pneumothorax after chest tube insertion

Answer 68

CI in presence of acute, unresolved pneumothorax No travel for 2-3 wks after radiographic resolution of pneumothorax

Answer 69

avoid scuba, contact sports + trauma

Answer 70

Benign condition of physiologic adaptation d/t increased cardiac workload

Answer 71

Bradycardia, midsystolic murmurs which resolve w/ valsalva, 3rd + 4th HS

Answer 72

Sinus brady Early repolarization: J-point elevation, ST elevation, J waves, or terminal QRS slurring in the inferior and/or lateral leads Normal when present in isolation Juvenile T wave inversion in leads V1-3 Sinus arrhythmia: Physiologic heart rate variation associated with respirations (increased with inspiration; decreased with expiration) Resolves with onset of exercise Junctional escape rhythm: QRS rate faster than resting P wave Regular R-R interval Sinus rhythm should resume with activity. 1st degree or Mobitz 1 2nd degree AV block present at rest Increased QRS voltage (LV hypertrophy) Incomplete RBBB

Answer 73

Echo findings Biventricular hypertrophy CXR findings Cardiomegaly Globular appearance Increased pulmonary vascular markings

Answer 74

Left axis deviation Left atrial enlargement Right axis deviation Right atrial enlargement Complete RBBB

Answer 75

In isolation, no need for further evaluation. Two or more, further evaluation needed

Answer 76

Cardiomyopathy, congenital coronary artery anomalies, ion channel disorders (eg Brugada) ECG, echo, stress test, consider cardiac MRI

Answer 77

Coronary artery arthrosclerosis, congenital coronary artery anomalies, cardiomyopathy ECG, echo, stress test, consider cardiac MRI

Answer 78

SVT, ventricular arrhythmias, premature atrial and ventricular contractions, sinus tachycardia, cardiomyopathy, ion channel disorders ECG, echo, stress test

Answer 79

Cardiomyopathy, myocarditis ECG, echo, stress test, consider pulmonary function testing

Answer 80

ACE inhibitors

Answer 81

Abnormal adduction of vocal cords during exercise Throat tightness, choking, SOB, cough, wheeze, worse during maximal exertion, resolves after five minutes. Inspiratory stridor No sx outside of exercise

Answer 82

Laryngoscopy (direct during exercise) manage underlying factors (postnasal drip, GERD, laryngeal polyps) Education SLP for breathing + postural techniques

Answer 83

Recent joint injection or surgery Trauma RA OA Joint replacement IVDU Intravascular devices STI risk Diabetes, immunocompromised Young or old

Answer 84

Rapid onset for arthritis but can be insidious w/ bursitis Knee > hip > shoulder, ankle, wrist, elbow Fever/ chills Recent infection elsewhere (URTI, UTI, strep throat, PNA, STD, diarrhea)

Answer 85

Hip held in flexed + externally rotated position Febrile, tachycardic Warm, swollen joint Reduced ROM Pain

Answer 86

Blood culture, CBC, CRP, uric acid, blood glucose Aspirate for gram stain, culture, leuks, glucose, crystals. PCR if ?lyme dz

Answer 87

Cellulitis Allergic reaction to injection Reactive synovitis Gout Pseudogout RA Osteomyelitis Lyme disease

Answer 88

Admit Empiric broad spectrum abx (ceftriaxone if gram negative, vancomycin if gram positive) 4 wks Assess therapeutic response w/ serial synovial fluid analysis

Answer 89

Death Impaired joint function Septic necrosis Ankylosis Osteomyelitis

Answer 90

Clean skin Freeze w/ lidocaine (25G needle) Find the posterior tip of the acromion and insert 18G needle about 1 cm below that landmark Completely advance the needle in a perpendicular direction under the acromion, aiming in a slightly cephalad direction

Answer 91

Normal Transparent, clear WBC <50 / <200 <25% polymorphonuclear leukocytes Negative culture Glucose similar to serum Noninflammatory Transparent, yellow WBC 50-1000 / 200-300 <25% polymorphonuclear leukocytes Negative culture Glucose similar to serum Inflammatory Translucent to opaque Yellow to opalescent WBC 1000-75,000 / 300-50,000 >50% polymorphonuclear leukocytes Negative culture Lower than serum Purulent Opaque Yellow to green WBC >75,000 / >50,000 >75% polymorphonuclear leukocytes Positive culture Much lower than serum Hemorrhagic

Answer 92

Open or compound fracture Surgical manipulation (orthopedic, colorectal, genitourinary procedures) Intravenous (IV) drug abuse Immunosuppression (AIDS, chronic steroid use) Peripheral vascular disease/peripheral neuropathy (diabetes mellitus) Sickle cell disease Genitourinary or biliary tract infection Chronic joint disease Presence of prosthetic orthopedic device Low socioeconomic status Infancy Elderly Alcoholism History of tuberculosis (Pott disease)

Answer 93

Fever, chills, fatigue Restricted ROM, pain, edema Limp Ulcers

Answer 94

Fever (temperature >100.4°F) but not always present Tenderness to palpation, swelling, erythema, warmth over involved area Fluctuance Decreased use of extremity, refusal to bear weight Limited movement of adjacent joint

Answer 95

CBC, CRP, ESR Blood culture Bone biopsy - gram stain, culture XR - osseous changes appear 2 wks after sx onset MRI if <2 wks sx

Answer 96

Acute leukemia Acute rheumatic fever Rheumatoid arthritis (adult or juvenile) Acute gout, pseudogout Cellulitis Malignant bone tumors (Ewing sarcoma, osteosarcoma) Septic arthritis Multiple myeloma (elderly) Sepsis Deep vein thrombosis, thrombophlebitis Intervertebral disk disorders Fracture Aseptic bone infarction Neuropathic joint disease (Charcot arthropathy) Transient synovitis

Answer 97

Empiric abx - vancomycin + ciprofloxacin Duration Kids - 4 days IV then 4 wks PO Adults - 6 wks IV - can then do PO for 3-4mo if hardware is infected Surgery if abx fail or infected surgical hardware Hyperbaric oxygen may be helpful Immobilization of affected part

Answer 98

Include bone abscess, bacteremia, fracture, loosening of hardware, overlying cellulitis, and draining soft tissue tracts. Sinus tract formation may be associated with neoplasms, especially with long-standing infection: Squamous cell carcinoma (Marjolin ulcer) most common tumor associated with chronic osteomyelitis Recurrence

Answer 99

Epstein Barr virus

Answer 100

Prodrome of malaise, fatigue Sore throat, fever, lymphadenopathy HA LLQ pain Infectious contacts

Answer 101

Fever HEENT Exudative pharyngitis Enlarged cervical, axillary, inguinal lymph nodes Palatal petechiae Periorbital edema Hepatomegaly, percussion tenderness common Splenomegaly

Answer 102

Labs - CBC, liver function >50% lymphocytes 10% atypical lymphocytes Mono spot - repeat 1 wk later - if negative but strongly suspicious, do IgM ab to EBV Throat C+S US abdo for spleen size

Answer 103

Primarily must be differentiated from nonspecific viral syndromes, lymphoma, leukemia, and Streptococcus pharyngitis. Concomitant Streptococcus infection is not uncommon. Many infectious agents may cause mononucleosis-like syndromes: cytomegalovirus, adenovirus, hepatitis A, human herpesvirus 6, HIV, rubella, toxoplasmosis. Medications causing mononucleosis-like syndromes: phenytoin, sulfa drugs

Answer 104

Supportive Prednisone if impending airway obstruction from ++ tonsils, or enlarged spleen, myocarditis or hemolytic anemia Avoid alcohol Infectious precautions Discuss splenic rupture sx Avoid amox - gives rash

Answer 105

As soon as asymptomatic for light, non contact sport (usually 3 wks) 1mo for contact unless splenomegaly evident or ongoing sx, consider US at 1mo before RTP <12cm normal spleen size Spleen to kidney ratio should be <1.25

Answer 106

Airway obstruction PNA Szs, meningoencephalitis GBS Hemolytic anemia, thrombocytopenia Bacteremia Hepatitis Splenic rupture

Answer 107

Stool cultures Peripheral blood smear

Answer 108

If <5% dehydration - give oral rehydration If >5% dehydration - IV NS Ciprofloxacin 500mg PO BID x3/7 OR azithromycin 1000mg PO x 1 dose Imodium (consider for comp) Pepto bismol

Answer 109

Pepto bismol 2 tabs at meals + 2 tabs QHS - take while on trip - reduces risk by 65% SE: darkening of stool + tongue Don’t take longer than 4 wks Interferes w/ doxycycline (used as a malaria prophylaxis - stagger meds)

Answer 110

Leave playing field, only return once given medical clearance (bleeding controlled, lacerations covered) Uniform should be disinfected or changed if bloody

Answer 111

Acute infection (fatigue, fever) - remove from play Remove from close combat sports until loss of infectivity known (HBV antigen - can last up to 20 wks) HBAg + - remove athlete indefinitely from contact sport

Answer 112

Hepatitis B vaccine Clean dressing rooms Washing soiled clothing, equipment, and services Avoid sharing towels and drinks Manage cuts and abrasions No sharing of razors and toothbrushes Cover broken skin Wear disposable gloves when coming in contact with blood

Answer 113

Keep stresses to a minimum Well balanced diet Avoid over training Adequate sleep Avoid rapid wt loss Keep hands away from eyes + nose Avoid sick contacts Moderate training decreases risk but intense training increases risk

Answer 114

Abrasions or physical trauma increase the likelihood of acquiring infection. Physical and mental stressors (i.e., weight loss, sleep deprivation, competition, school responsibilities) may increase likelihood of recurrence. Close skin contact sports like wrestling

Answer 115

Prodrome of burning, stinging, itching then clusters of vesicles Can get fever, lymphadenopathy, malaise, pharyngitis w/ initial episodes

Answer 116

Viral culture or Tzanck smear PCR is gold standard

Answer 117

Impetigo Herpes zoster Folliculitis Allergic or contact dermatitis Tinea gladiatorum Cellulitis

Answer 118

Acyclovir 200 mg 5 times a day or 400 mg TID for 10 days Valacyclovir 1 g BID for 10 days During the ulcer stage, benzoyl peroxide and use of a hair dryer can help dry crusts more rapidly and minimize secondary bacterial infections.

Answer 119

Scabbed over, no discharge, no evidence of secondary bacterial infection No new lesions in 48-72hrs No lymph node swelling in affected area Primary episode - should be treated for 5 days before RTP, 14 days if systemic sx present Recurrent episode - should be treated for 5 days

Answer 120

Isolate infected wrestler to prevent skin contact with other wrestlers (control outbreaks among previously infected wrestlers). Regular wrestling matt cleaning and general hygiene (e.g., avoid sharing towels, soap, razors) Consider using prophylactic antiviral medications during the season or before competition Acyclovir 200 mg BID Valacyclovir 500 mg or 1 g daily Famciclovir 250 mg BID Teach skin hygiene (e.g., showering after activity), and protect other skin abrasions from secondary contact. Educate athletes on how to identify lesions/recurrence, and seek early treatment

Answer 121

bullous + non bullous Bullous Caused by epidermolytic toxin from S. aureus Favors intertriginous areas Is a localized form of scalded skin syndrome Starts as a vesicular eruption that develops into bullae and then may rupture to form honey crusts Non bullous more contagious Caused by S. aureus and group A β-hemolytic streptococcus (GAS) Starts as macules or papules and progresses to vesicular eruption, which rupture to form erosions with honey crusts

Answer 122

Abrasions or cuts Sweat or water soaked clothes Poor hygiene

Answer 123

Avoid sharing equipment, towels, tape, and ointments. Avoid dispensing ointments from common containers. Clean equipment and clothes daily. Shower immediately after sports activity with antibacterial soap. Avoid communal hot tubs. Wear moisture-wicking, synthetic clothing. Discourage body shaving in contact sports. Frequent skin checks by athletic trainers and athletes in contact sports Frequent handwashing by athletic trainers and affected athletes Cover any injured skin immediately. Use topical triple antibiotic for skin wounds

Answer 124

Bullous: Starts with superficial vesicles, which progress to flaccid bullae without surrounding erythema When the bullae rupture, they ooze and create honey-colored crusts. Self-limited and may spontaneously resolve in weeks if left untreated Nonbullous: Starts as a single macule or papule that develops into a vesicle Vesicle may rupture and form an erosion, and the contents become honey-colored crusts that are often pruritic. May spontaneously resolve without scarring if left untreated for weeks

Answer 125

Soak affected skin in warm water for 5 to 10 min 3 times daily until cleared. Gently remove honey-colored crusts to improve antibiotic penetration. Topical mupirocin BID x5 If widespread, add amox-clav or keflex x7/7 If MRSA, clindamycin x7/7

Answer 126

Oral abx x72hrs No new lesions for 48hrs No moist or exudative lesions

Answer 127

Poststreptococcal glomerulonephritis up to 3 wk after skin infection: Occurs in 20% of nonbullous-type impetigo Risk not decreased with antibiotic treatment Hyperpigmented area after healed lesions mostly in dark-skinned athletes Cellulitis Lymphangitis Guttate psoriasis Toxic shock syndrome Staphylococcal scalded skin syndrome Sepsis Osteomyelitis Pneumonia

Answer 128

RTP: 72 hrs of treatment, 48 hrs of no new lesions, lesions cannot be draining Carbuncle/ abscess - needs I+D

Answer 129

Watchful waiting - usually resolve within 6-12mo Can use LN2, curettage, salicylic acid Wait 24hrs after lesions resolve to compete in contact sports

Answer 130

Rx w/ topical terbinafine 1% BID x1 wk If severe or extensive, oral terbinafine 250mg daily x2-6 wks No limits for RTP Educate re footwear in showers, drying, don’t share towels

Answer 131

Rx w/ topical clotrimazole 1% or terbinafine 1% BID x2-4 wks oral/topical antifungal tx x 72 hrs on skin + lesions must be covered

Answer 132

Terbinafine 250mg PO daily x4 wks oral/topical antifungal tx x 14 days on scalp

Answer 133

Jock itch Rx w/ topical clotrimazole 1% or terbinafine 1% BID x2-4 wks oral/topical antifungal tx x 72 hrs on skin If coverable, and under treatment, can participate earlier

Answer 134

No extensive or purulent draining lesions, covering not permissible

Answer 135

If cannot be covered, cannot wrestle Solitary or scattered lesions can be curetted prior - no seeping

Answer 136

drain fluid w/ needle + syringe, inject space w/ diluted betadine, leave until stinging stops then drain betadine. Create foam donut and place around blister, cover hole in middle w/ 2nd skin, secure dressing w/ tape Management of open blister Clean, dry, leave open when not training, offload w/ foam donut when training

Answer 137

Family history Screen for RED-S Screen for CV dz (syncope, palpitations, signs of marfans) Provide education, counselling, intervention for general wellness and injury prevention

Answer 138

Early repolarisation Incomplete RBBB Sinus bradycardia First degree AV block Voltage criteria for LVH

Answer 139

High false positive rate Lack of qualified interpreters of young athlete ECGs

Answer 140

Athletes + staff PMH Injuries Illnesses Allergies - epi pen Med list Ensure no banned substances Meds in original bottles Immunisations Dental check up Medic alert bracelets Passport expiry dates Visa requirements Medical insurance Emergency contacts Food + water Avoid uncooked foods, unpeeled veggies, street food, unpasteurised dairy Bottled water only Avoid ice cubs Wash hands w/ alcohol gel Hygiene + infection control No fresh water swimming Walk in shower w/ sandals Mosquito repellant, long sleeve shirts No contact w/ animals General Advice Sun protection No tattoos Safe sex, condoms Doc + supplies Malpractice insurance Contact host medical, embassy, hospitals, physicians Disaster planning Transfer of care/ medical records Forms (Wada list, TUE, rx pad, encounter notes, SCAT6) Jet lag Sleep Nutrition Acclimatisation Travel Hydration illness prevention Med bag Cover letter for medical kit Prophylaxis meds (malaria, altitude, travels diarrhea, probiotics, STIs) Be familiar with medical kit Post trip Check in re illness

Answer 141

MMR TdaP Varicella Hep B Hep A Meningococcal HPV BCG Cholera Japanese encephalitis Rabies Tick borne encephalitis Influenza Post splenectomy - add: Pneumovax HiB

Answer 142

Location Urban/ rural, domestic/ international Proximity to local medical resources Medical conditions (malaria, zika) EAP for each venue Customs/ regulations/ culture Different anti doping rules Language Environment Climate, altitude Sport Athletes, gender, age, support staff Communication Between athletes + staff SIM card/ internet access

Answer 143

Who Athletes Numbers Skill level Ages Prior information Crowd Numbers Seated or mobile Medical care Staff - ratio of staff to participants Roles Medical AT, chiro, PT, RMT, ED doc, sports med doc Notify ED dept Credentials Attire What Sport Type of event Most common type of injury Duration of event Where Venue Med room, change rooms AED location Meal areas Fenced or unfenced, access points Paramedics, access points + exit, aid stations Medical Local ED Environment Weather - temp, humidity Altitude, water, terrain How Procedures: Roles Call, charge, control Scope of care When to send for further care Location of medical staff, aid tents etc Record keeping Orientation Practice scenarios EAP Transportation Weather, appropriate vehicle, monitoring during transport, medical personnel on transport Equipment + supplies Communication radios, phones Universal signs Mitigate risks Ensure adequate access to water for athletes + spectators and communication strategy to stay hydrated Prevent exposure w/ water sprinklers, shade, advisories to wear a hat, blankets, heated areas Identify and fence off hazards, guide pedestrian flow to safer areas, adequate lighting, signage, ensure no overload of structures Worst possible scenario Disaster planning

Answer 144

Arms crossed over chest - no help needed 1 arm raised straight in air - require extra assistance 2 arms raised + crossed overhead - activate EAP, require EMS

Answer 145

General: chairs, tables, exam beds, stretchers, garbage, toilets, sheets, towels, curtains/dividers, disinfectant, gloves, masks, gowns, computer, paper/pens for documentation Diagnostics: stethoscope, BP cuff, O2 sat, POC glucose, POC Na, ophthalmoscope, otoscope, rectal thermometer Emergency: oral airways, resuscitation masks, AED, O2 tank and equipment, spinal board, ice water tub, water, ice, IV equipment, IV fluid (NS, 3-5% hypertonic solution, D50), glucose, electrolyte drinks, drinking cups, urine dipsticks, blankets Medications: epi 1:1000, dexamethasone, dextrose 50% (D50), cardiac meds (atropine, lidocaine), local anesthetic (xylocaine); salbutamol; ASA, APAP, NSAID, nitroglycerine, loperamide, antihistamine; lubricant for chafing, proparacaine (eye) Wound care: gauze, bandaids, tensors, tape, slings, disinfectant, splints, suture kits, syringes, needles, scalpel, scissors, eye pads, dental kit

Answer 146

Transportion from venue to medical facility Map of facility inc exits + access points, AED location, location of staff Addresses of facilities nearby Contact phone numbers, radio channels Call (calls 911, calls venue organizers, calls ahead to ED, calls athlete emergency contact), charge (enters field of play, in charge of medical care) + control person (controls crow, clears pathway for EMS) Identify + list emergency equipment + roles GPS coordinates for helicopter When to activate EAP? If athlete not breathing, no pulse, bleeding profusely, impaired consciousness, injured neck, back or head or visible major trauma to limb

Answer 147

Mandate a maximum group size Regulate the start line/course with Time the gaps between waves Consider the number and visibility of boys Consider straight line distance before requiring swimmers to take a turn, allowing them to spread out Ask swimmers to select into waves of appropriate ability Facilitate a climatisation and anxiety reduction, including pre-race immersion Increase the amount of cover in the first part of the swim

Answer 148

Adapt schedule (early AM or late PM) Communicate information to athletes about the weather and how to prepare Event modification in case of extreme environmental conditions (extra breaks, reduced climbing/ distance)

Answer 149

2 out of 3: Potential to enhance performance. Potential to be detrimental to health Violate the spirit of sport

Answer 150

Pt requires it to stay healthy No reasonable alternatives Pt will not surpass a normal state of health

Answer 151

Presence of a substance Use of a substance Evading or reducing Whereabouts failures Tampering Possession Trafficking Administration Complicity Prohibited association

Answer 152

Suspension for 2-4 yrs to life

Answer 153

Substances and methods prohibited at all times, in and out of competition Nonapproved substances, anabolic agents, peptide hormones, growth factors, beta 2 agonists, hormone and metabolic modulators, diuretics and masking agents Prohibited methods (in + out of comp) Manipulation of blood and blood components, chemical and physical manipulation, gene doping Prohibited classes of substances (in comp only) Stimulants, narcotics, cannabinoids, glucocorticosteroids Substances prohibited in particular sports beta blockers

Answer 154

Benefits Increases red blood cell (RBC) count → enhances oxygen delivery → improved endurance Used medically for anemia (e.g., CKD patients) Risks & Side Effects Cardiovascular: Thickened blood (polycythemia) → increased risk of DVT, stroke, MI Hypertension: Due to increased blood viscosity Flu-like symptoms: Headaches, fatigue Risk of undetected doping: Banned in most sports

Answer 155

possible increased growth, allergic reactions, acromegaly

Answer 156

Possible anabolic effects, tachycardia, tremor, palpitations

Answer 157

Rapid weight loss, decreases concentration of drugs in urine Electrolyte imbalance, dehydration, muscle cramps

Answer 158

Increased alertness, improved performance Anxiety, insomnia, hypertension, arrhythmias

Answer 159

Improved endurance, transfusion reaction, increase blood viscosity

Answer 160

ADHD meds, ephedrine, epinephrine, cocaine

Answer 161

Training - duration, results, goals Diet - food groups, calories Meds + supplements Prior steroid use

Answer 162

Benefits Significant increases in muscle mass, strength, and endurance Faster recovery from training and injuries Risks & Side Effects Cardiovascular: Dyslipidemia (↑ LDL, ↓ HDL), increased risk of stroke and heart attack Endocrine: Hypogonadism, infertility, gynecomastia, virilization in females Hepatic: Liver toxicity, cholestasis (especially with oral steroids) Psychiatric: Mood swings, aggression ("roid rage"), dependence Musculoskeletal: Premature closure of growth plates in adolescents

Answer 163

Systemic use prohibited - IM/IV/PO/rectal (rectally inserted hemorrhoid cream or suppository) Topical use allowed (derm or hemorrhoidal), local intra-articular injection allowed Inhaled allowed for asthma but daily max limit Symbicort, advair, combivent, serevent - max 200mcg/ 24hrs Singulair (montelukast) not prohibited

Answer 164

LABA/ SABAs All are banned at all times Exceptions for inhaled salbutamol (1600mcg/ 24hr, not to exceed 800mcg/ 12 hrs) - 1 puff inhaler = 100mcg - 1 puff diskus = 200mcg Formoterol - max 54mcg/ 24hrs Salmeterol - 200mcg/ 24hrs

Answer 165

IV infusion >50ml in any 6hr period are prohibited unless: Used legitimately during hospital admission, surgical procedure or approved clinical investigation Prohibited at all times, in and out of competition

Answer 166

In + out of competition Archery Shooting In competition Ski jumping, freestyle, snowboard halfpipe + big air Automobile Billiards Darts Golf Underwater sports (spearfishing, target shooting)

Answer 167

To monitor selected biological variables over time that indirectly reveal effects of doping Hematological modules - profile of haem variables for detection of blood doping Steroidal modules - urinary steroid concentrations over time

Answer 168

Information = knowledge in raw form Intelligence = information plus analysis

Answer 169

Anti doping administration + management systems Monitor athlete’s whereabouts, biological passport, competition schedules, TUEs, prior tests

Answer 170

In competition for air sports, archery, automobile, powerboating

Answer 171

Okay to use in emergency but WADA requires emergency TUE be submitted following treatment

Answer 172

Required before using prohibited substance or method Valid for duration of treatment, max 4 yrs

Answer 173

Form completed by athlete + physician Comprehensive medical hx Results of exams/ tests/ imaging/ investigations Independent medical opinion in the case of non-demonstrative condition Relevant correspondence between physicians regarding dx + rx

Answer 174

Dx by a specialist in management of ADHD Must have evidence of standard diagnostic criteria Evidence of sx onset before 12 Athlete ideally on stable dose of medication Evidence of other interventions (psych, behaviour management) Regular review (min annually) by the same specialist physician

Answer 175

Any quantity of substance subject to threshold limits (asthma, epherine, pseudoephidrine) in conjunction w/ diuretic (or masking agent) requires a TUE for both diuretic + threshold substance

Answer 176

>40 + CNS sx

Answer 177

Breast cancer, diabetes, female infertility, PCOS

Answer 178

Use global DRO to check meds Use CCES website medical exemption wizard to find out what organisation to submit application to

Answer 179

Use CCES website medical exemption wizard to find out what organisation to submit application to (eg international federation vs CCES) Complete form, including physician letter + documentation to support diagnosis

Answer 180

Male hypogonadism

Answer 181

Anaemia, male hypogonadism, growth hormone deficiency

Answer 182

ADHD, cold + flu sx, anaphylaxis

Answer 183

Testosterone

Answer 184

EPO, LH, GnRH

Answer 185

Letrozole, clomifene, tamoxifen, insulin

Answer 186

Acetazolamide, spironolactone, HCTZ, furosemide, mannitol, desmopressin

Answer 187

IM, IV, PO, PR banned but inhaled, topical, intranasal okay Betamethasone, budesonide, prednisone

Answer 188

Mild inflammatory lesions caused by exposure to cold after longterm exposure to non freezing, damp conditions Itch/ pain/ swelling + blanch able erythematous/ violet discolouration, occurs 12-24hrs after exposure

Answer 189

Supportive Nifedipine can expedite healing + prevent recurrence

Answer 190

Soft tissue injury from prolonged cooling, usually with moisture Tingling that progresses to numbness

Answer 191

High = 1500-3500m Very high = 3500-5500m Extreme = >5500m

Answer 192

Hypoxia causes hyperventilation which leads to respiratory alkalosis This leads to a compensatory metabolic acidosis Increased pH induces a leftward shift of Hb dissociation making it easier for Hb to be saturated w/ O2

Answer 193

Decreased exercise tolerance Sleep quality reduced Appetite suppression Peripheral vasoconstriction leading to fluid retention Wt loss

Answer 194

Photokeratitis High altitude has increased UV rays, worsened by reflection from snow, leading to transient eye injury Sx: pain, lacrimation, FB sensation, eyelid twitching

Answer 195

Increased uptake of fluorescein Cover eyes w/ UV protection (goggles), artificial tears, cold compress

Answer 196

Benefits Increased muscle mass and strength Enhanced recovery from exercise Improved bone density Increased red blood cell production May improve mood and libido Risks & Side Effects Cardiovascular: Increased risk of hypertension, thrombosis, myocardial infarction Endocrine: Suppression of natural testosterone production, leading to testicular atrophy, infertility, and gynecomastia Psychological: Mood swings, aggression, irritability Liver: Risk of liver damage, particularly with oral forms Other: Acne, hair loss, prostate hypertrophy

Answer 197

Benefits Increased ATP regeneration → improved strength, power, and short-duration performance Promotes lean muscle mass gain May aid in post-exercise recovery Potential neuroprotective effects Risks & Side Effects Water retention (can cause weight gain) GI discomfort (bloating, diarrhea in some individuals) Kidney concerns in pre-existing renal disease (but safe in healthy individuals)

Answer 198

Benefits Slow digestion → provides prolonged amino acid release (ideal for nighttime recovery) Supports muscle protein synthesis and recovery High in calcium and bioactive peptides Risks & Side Effects Dairy allergy/lactose intolerance → potential GI discomfort Excess intake may contribute to kidney strain (in those with pre-existing renal disease)

Answer 199

Benefits: Rapidly absorbed, high in leucine → excellent for post-exercise recovery Supports muscle growth and repair Risks & Side Effects: Lactose intolerance may cause bloating, gas, diarrhea Kidney concerns in those with pre-existing renal disease

Answer 200

Benefits: Stimulates muscle protein synthesis (especially leucine-rich EAAs) Beneficial for recovery and muscle maintenance Risks & Side Effects: No significant risks, but redundant if consuming adequate protein

Answer 201

Benefits CNS stimulant → improves alertness, reaction time, endurance, and strength Enhances fat oxidation during exercise Reduces perceived exertion Risks & Side Effects Insomnia, anxiety, jitteriness Tachycardia, palpitations, increased BP GI distress (e.g., acid reflux) Diuretic effect (mild dehydration in excess) Withdrawal symptoms (headaches, fatigue)

Answer 202

Benefits Enhances nitric oxide (NO) production → vasodilation, improved oxygen delivery May improve endurance and high-intensity exercise performance Risks & Side Effects Hypotension, dizziness (especially in individuals on antihypertensive meds) GI upset (bloating, nausea) Methemoglobinemia (rare but possible in very high doses)

Answer 203

Benefits Increases muscle carnosine levels → buffers lactic acid → delays fatigue in high-intensity exercise Beneficial for activities lasting 1–4 minutes (e.g., sprinting, rowing, wrestling) Risks & Side Effects Paresthesia (tingling sensation) → dose-dependent, transient, harmless No major long-term risks identified

Answer 204

Benefits Acts as a buffer, reducing muscle acidity and delaying fatigue Useful for high-intensity sports (e.g., swimming, sprinting, combat sports) Risks & Side Effects GI distress (bloating, nausea, diarrhea) → common at high doses Metabolic alkalosis (with excessive intake)

Answer 205

general: wt loss, reduce friction mild: topical clindamycin, oral doxycycline for 3mo mod: Doxycycline x3 mo. consider spiro or Humira (biologic), I+D severe: wide excision, biologics resistant cases: oral Clindamycin + rifampin x3mo

Answer 206

May prevent or delay onset of T2DM in at risk people Weight loss/maintenance Increased insulin sensitivity Improved lipids, blood pressure, glycemic control Decreased cardiovascular disease Decreased overall mortality

Answer 207

Hypoglycemia or hyperglycemia Foot injuries due to neuropathy Exacerbation of microvascular complications (eg. retinopathy) Injury due to autonomic dysfunction (eg. heat related illness)

Answer 208

History Insulin regimen Basal/bolus insulin type and dose Continuous subcutaneous insulin infusion (CSII) Compliance Glycemic control Hypoglycemia episodes/insensitivity Diet and calorie intake Current exercise Diabetic complications Peripheral neuropathy, retinopathy, nephropathy, foot ulcers

Answer 209

Children and adolescents with diabetes (type 1 or 2) should engage in 60 min/day or more of moderate to vigorous intensity aerobic activity Include muscle and bone strengthening activities (resistance training) at least 3 days/week

Answer 210

A diabetic diet is a healthy diet Aim for ≥50% of calorie intake from fiber-rich carbohydrate sources Limit saturated fats, refined carbohydrates, alcohol Aim for ≥5 portions of fruit or vegetables per day Spread food intake evenly across the day Snacks may be needed before, during, and after exercise to maintain blood glucose in a normal range Risk of nocturnal hypoglycemia after exercise may be mitigated with reduction in basal insulin dose or a bedtime snack

Answer 211

If using continuous subcutaneous insulin infusion (CSII) Reduce or stop insulin infusion during exercise to avoid hypoglycemia Pump should be removed for contact/collision sports and the catheter site protected Remove pump 30min before exercise lasting <1h Hourly bolus of insulin, approximately 50% of normal hourly basal rate, may be needed for exercise lasting >1h Blood glucose checks 2-3x at 30 min intervals prior to exercise Q30 min during exercise Q2h after exercise

Answer 212

Check blood glucose before and after exercise Determine a safe blood glucose range prior to exercising (5.5-13.9 mmol/L) Coaching staff should be aware that the patient has diabetes, know the signs/symptoms of hypoglycemia, and have a hypoglycemia EAP Have blood glucose monitor available Have sugar (15g per 30 min) available to treat hypoglycemia Wear appropriate, well-fitting shoes and good socks, check feet and legs after exercise to ensure no wounds (if neuropathy) Hydration is important during and after sport Medical alert bracelet Exercise with others

Answer 213

Overuse injury resulting in pain posterior to the medial malleolus Can be divided into 3 stages Stage 1: mild swelling, medial ankle pain, normal but painful heel raise Stage 2: flattening of arch, flexible hindfoot, inability to perform heel raise Stage 3: fixed hindfoot deformity

Answer 214

Recent increase or change in training Surgical or accidental trauma to foot Severe pronation Local steroid injection (risk of tendon rupture) Associated with HTN, diabetes, obesity, RA, seronegative arthritis

Answer 215

Pain along posterior tibialis tendon, particularly near medial malleolus Recent change in activity type, frequency, or intensity Medial arch pain Radiation to medial calf Worse with prolonged or strenuous activity, push-off motion Painful or absent heel raise

Answer 216

Tender over posterior tibialis tendon, particularly near medial malleolus Medial ankle/foot swelling Flattened longitudinal arch Increased hindfoot valgus (too many toes sign) Pain/weakness with repetitive heel raises Pain/weakness with resisted inversion in plantarflexion

Answer 217

Flexor hallucis longus tendinopathy Flexor digitorum longus tendinopathy Subluxation/dislocation of tibialis posterior tendon Tarsal tunnel syndrome Stress fracture or fracture Medial ankle (deltoid ligament) sprain

Answer 218

Relative rest Calf stretching Eccentric exercises Medial arch support (OTC or custom orthotics) Steroid injections not recommended Surgery rarely if failed conservative treatment, fixed deformity

Answer 219

Orthostatic vitals Cardioresp Sit to stand in 30s Rombegs Tandem stance Time up + go (stand, walk 3m, turn, walk back + sit) <10s = normal, 10-20s good mobility but needs some assistance, >30s = poor mobility

Answer 220

heart condition CP during activity CP at rest loss of balance, dizziness bone or joint problem BP or heart drugs

Answer 221

AAA Aortic stenosis CHF unstable angina Acute MI myocarditis PE thrombophlebitis ventricular tachycardia acute infections

Answer 222

Cardiac enlargement Supraventricular dysrhythmias Uncontrolled HTN HOCM Uncontrolled diabetes Uncontrolled thyrotoxicosis Complicated pregnancy

Answer 223

Exercise testing first Slow progression of exercise May need to exercise under medical supervision

Answer 224

Relaxation + breathing exercises Breath control Avoid hyperventilation

Answer 225

Hypovolemic meds (diuretics), hypotensive meds, cardiac meds, anticholinergics, altered LOC meds, anti-hypogylcemics, blood thinners

Answer 226

Tarsal tunnel syndrome (TTS) is a compressive neuropathy of the posterior tibial nerve as it passes through the tarsal tunnel, located on the medial side of the ankle beneath the flexor retinaculum.

Answer 227

Intrinsic causes: Ganglion cysts, lipomas, varicose veins, hypertrophic flexor retinaculum Extrinsic causes: Trauma, fractures, excessive pronation, space-occupying lesions Systemic causes: Diabetes, inflammatory arthritis

Answer 228

Pain and paresthesia in the medial ankle, heel, and plantar foot Symptoms worsen with activity and improve with rest

Answer 229

Tinel’s sign: Tingling over the tarsal tunnel with percussion Passively dorsiflex the ankle and evert the foot while extending the toes; hold for 10–30 seconds - pain or paresthesias is a positive finding

Answer 230

Conservative: Rest, orthotics (correct overpronation), NSAIDs, physiotherapy Invasive: Corticosteroid injections for inflammation Surgical: Tarsal tunnel release for refractory cases

High Yield 6 Flashcards

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